Frontiers in public health · 2025
Socioeconomic disparities in HPV vaccine uptake: multivariable analysis of vaccination data from Tianjin (2018-2023).
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Xiang Jing, Sun Xuan
Аннотация
OBJECTIVES: As the first socio-demographic profiling of HPV vaccines in Chinese cities, this study assesses equity implications through compositional analysis of covered populations, with multilevel examination of vaccine-type selection determinants.
METHOD: Utilizing HPV vaccination data obtained from the Jinnan Center for Disease Control and Prevention (CDC) spanning from 2018 to 2023, we conducted a retrospective analysis. Hierarchical logistic regression was employed to model the joint effects of age, ethnicity, occupation, and urban-rural residence on vaccination behaviors. Vaccine type preference was categorized as bivalent, quadrivalent, or nonavalent.
RESULT: Three key disparities were revealed in the analysis. Age-stratified access revealed the highest proportion of recipients among women aged 33-38 years (29.6%) and 39-44 years (21.9%), contrasting with less than 1% participation in the 9-14 year-old cohort. Educationally, 87.3% held at least a bachelor's degree, compared to 12.7% with below-college education (χ 2 = 6048.89, p < 0.001). Clear urban-rural divide, with 99.7% of recipients in urban areas and just 0.3% in rural areas (χ 2 = 76.79, p < 0.001). Vaccine-type selection showed socioeconomic patterns, with nonavalent vaccines preferred by urban professionals (OR = 1.577, 95% CI: 1.16-2.142) and those with incomes above 5000 yuan (OR = 1.958, 95% CI: 0.26-3.527).
CONCLUSION: Demonstrating Hart's Inverse Care Law, Tianjin's program disproportionately immunizes socioeconomically secure urbanites. We propose: (1) school-based mandates for pre-sexual debut cohorts; (2) rural vaccination-social insurance integration; (3) domestic 9-valent vaccine development with needs-based subsidies. These evidence-based reforms are critical for achieving equitable 90% coverage by 2030.
METHOD: Utilizing HPV vaccination data obtained from the Jinnan Center for Disease Control and Prevention (CDC) spanning from 2018 to 2023, we conducted a retrospective analysis. Hierarchical logistic regression was employed to model the joint effects of age, ethnicity, occupation, and urban-rural residence on vaccination behaviors. Vaccine type preference was categorized as bivalent, quadrivalent, or nonavalent.
RESULT: Three key disparities were revealed in the analysis. Age-stratified access revealed the highest proportion of recipients among women aged 33-38 years (29.6%) and 39-44 years (21.9%), contrasting with less than 1% participation in the 9-14 year-old cohort. Educationally, 87.3% held at least a bachelor's degree, compared to 12.7% with below-college education (χ 2 = 6048.89, p < 0.001). Clear urban-rural divide, with 99.7% of recipients in urban areas and just 0.3% in rural areas (χ 2 = 76.79, p < 0.001). Vaccine-type selection showed socioeconomic patterns, with nonavalent vaccines preferred by urban professionals (OR = 1.577, 95% CI: 1.16-2.142) and those with incomes above 5000 yuan (OR = 1.958, 95% CI: 0.26-3.527).
CONCLUSION: Demonstrating Hart's Inverse Care Law, Tianjin's program disproportionately immunizes socioeconomically secure urbanites. We propose: (1) school-based mandates for pre-sexual debut cohorts; (2) rural vaccination-social insurance integration; (3) domestic 9-valent vaccine development with needs-based subsidies. These evidence-based reforms are critical for achieving equitable 90% coverage by 2030.